Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 14, 2012; 18(26): 3409-3414
Published online Jul 14, 2012. doi: 10.3748/wjg.v18.i26.3409
Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation
Kensuke Takuma, Terumi Kamisawa, Taku Tabata, Seiichi Hara, Sawako Kuruma, Yoshihiko Inaba, Masanao Kurata, Goro Honda, Koji Tsuruta, Shin-ichiro Horiguchi, Yoshinori Igarashi
Kensuke Takuma, Terumi Kamisawa, Taku Tabata, Seiichi Hara, Sawako Kuruma, Yoshihiko Inaba, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
Masanao Kurata, Goro Honda, Koji Tsuruta, Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
Shin-ichiro Horiguchi, Departments of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
Yoshinori Igarashi, Department of Gastroenterology and Hepatology, Omori Medical Center, Toho University School of Medicine, Tokyo 143-8541, Japan
Author contributions: Takuma K and Kamisawa T contributed equally to this work, analyzed the data and wrote the manuscript; Tabata T, Hara S, Kuruma S, Inaba Y, Kurata M, Honda G, Tsuruta K, Horiguchi S and Igarashi Y collected the data.
Correspondence to: Terumi Kamisawa, MD, PhD, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. kamisawa@cick.jp
Telephone: +81-3-38232101 Fax: +81-3-38241552
Received: September 13, 2011
Revised: December 29, 2011
Accepted: January 18, 2012
Published online: July 14, 2012
Abstract

AIM: To clarify the strategy for early diagnosis of pancreaticobiliary maljunction (PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops.

METHODS: The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography (ERCP). Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM. Of these, patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation. The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated. Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted.

RESULTS: Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain (n = 16) or jaundice (n = 12). Radical surgery for gallbladder cancer was only possible in 11 patients (31%) and only 4 patients (11%) survived for 5 years. Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography (MRCP). The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer. All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred. Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls, and hyperplastic changes, hypertrophic muscular layer, subserosal fibrosis, and adenomyomatosis were detected in 7 (88%), 5 (63%), 7 (88%) and 5 (63%) patients, respectively. Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients.

CONCLUSION: To detect PBM without biliary dilatation before onset of gallbladder cancer, we should perform MRCP for individuals showing increased gallbladder wall thickness on ultrasound.

Keywords: Pancreaticobiliary maljunction; Pancreatobiliary reflux; Ultrasound; Gallbladder cancer; Endoscopic ultrasonography